Nursing Management of the Newborn; Essentials Of Maternity, Newborn, And Women’s Health Nursing

Chapter 18: Nursing Management of the Newborn

1. As a postpartum nurse your next client is an LGA baby boy who was born at 37 weeks’ gestation. He had Apgar scores of 8 and 9. He was circumcised. The mother is breast-feeding. Your unit requires a full assessment, screenings, discharge instructions, and documentation. (Learning Objectives 4, 7, 8, and 10)

1. Describe what a normal head-to-toe assessment would be for an infant born at 37 weeks’ gestation. What test is used to determine this gestational age? What is the scale used to determine the Apgar score, and are this baby’s scores normal?
2. As the discharging nurse, you are responsible for what screenings in an infant in the first 24 to 48 hours? What immunizations would be required?
3. What discharge instructions would be pertinent to this mother? How would you educate her or the family?
4. How would you document your discharge teaching? Write a sample narrative of your teaching.

2. You are the newborn nursery nurse and have been called to the labor and delivery suite to attend the delivery of a G5P4 mother whose pregnancy was complicated by gestational diabetes. At 2032 a male infant weighing 8 pounds 2 ounces was delivered vaginally with the assistance of a vacuum extractor. You have assigned Apgar scores of 7 and 9. (Learning Objectives 2, 3, 5, 6, and 8)

1. Relate the assessments you need to carry out in this immediate post-delivery time period.
2. Describe the nursing interventions you will perform before the baby is taken to the newborn nursery.
3. After taking the baby to the newborn nursery, you notice that the baby has developed diffuse swelling and bruising on the occiput of his head from the vacuum extractor use. Discuss how you would differentiate between a cephalhematoma formation and caput succedaneum development. Which one is more serious?
4. When the baby is 6 hours old, you notice that he has become jittery and is cyanotic. You check a heel stick blood sugar and it reveals a blood glucose level of 30. Discuss the immediate nursing interventions you will implement and what additional interventions you can implement to prevent this from occurring again in the future.

Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1 and 2)

1. Why is Teresa’s pregnancy considered a high-risk pregnancy?
2. Discuss potential pregnancy-related complications for Teresa.
3. Discuss the potential risks to the babies.

2. Sarah is 19-year-old G1P0 at 36 weeks’ gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)

1. Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.

Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

Case 1

Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared

1. Why is Teresa’s pregnancy considered a high-risk pregnancy

Incorrect answer.

Teresa’s pregnancy is considered high risk pregnancy because most of IVF pregnancies require induced labor or caesarean section. 

Also, most babies conceived through IVF are born prematurely or with a low birth weight. Incorrect.. there is a higher incidence of preterm birth due to multiple gestation, IVF itself does not increase the risk factor IVF increases the risk of Down syndrome as well. Incorrect as IVF allows for early genetic testing.

2.    Discuss potential pregnancy-related complications for Teresa.

What else?

Some of the potential pregnancy –related complications for Teresa are late miscarriage,  She is 26 weeks pregnant.. this is no longer a complication.

ovarian hyper stimulation syndrome, She is 26 weeks pregnant.. this is no longer a complication.

    This is for IVF not the pregnancy

high blood pressure, pre-eclampsia, premature delivery, low birth weight, 

birth defects,  Fetal not maternal

and stress. 

3.    Discuss the potential risks to the babies.

You only discuss problems of prematurity.. what else?

The babies are at a higher risk of being born with breathing problems because mostly twins who are conceived through in vitro fertilization are born prematurely and therefore it means that their respiratory system and organs like lungs are not fully developed. They are also at risk of jaundice or sepsis. 

Case 2

 Sarah is 19-year-old G1P0 at 36 weeks’ gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)

1.    Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.

this is a definition not a care plan

The best way to treat Sarah for preeclampsia is to deliver the baby because at 36 weeks’ gestation, the baby is full grown and it will be safer to deliver the baby and avoid further complications. In some cases, this condition may continue after delivery. So if this happens with Sarah, then she will be given intravenous medication to prevent seizures and control blood pressure.

Eclampsia can also be managed by delivering the baby. However, before the process of delivering the baby, immediate medical attention is required to treat the blood pressure levels, and stop the seizures. She will be given magnesium sulfate to stop the seizures and also prevent seizures in the future. Also, she will be given antihypertensive medications to stabilize the blood pressure (Plante & Ryan, 2020). HELLP syndrome will also be managed by delivering the baby. 

References 

Vlasyuk, V. (2019). What is the Cause of the Caput Succedaneum and the Region of Periosteal Blood Congestion of the Blood of the Skull?.

Plante, L. A., & Ryan, J. G. (2020). Preeclampsia, Eclampsia, HELLP Syndrome. In Evidence-Based Critical Care (pp. 749-757). Springer, Cham.